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tIt It NIt tt it 94 tt it tit 4t 44t Itlt,It v# iit tjiti�'"t 22Ip1t �// <br /> t APPLICANON ' PERMIT t SAN JOAN LOCAL HEALTH DISIF <br /> t UNDERGRON..,,ANK t 1601 E HAZELTON AVE., STOCF.TOk-wq, � IJ <br /> t CLOSURE OR ABANDONMENT t Telephone (209) 468-3420 I; IL) I 1 t7 <br /> APPLICATION FOR PERMANENT/TEMPORARY CLOSURE OR ABANDONMENT IN PLACE OF UNDERGROUND HAZARDOUS SUBSTANCES STORAGE FACILITY <br /> THIS PERMIT EXPIRES 90 DAYS FROM THE APPROVAL DATE. DO NOT WRITE IN ANY SHADED AREAS. INDICATE PERMIT TYPE BELOW; <br /> X__ REMOVAL _____ TEMPORARY CLOSURE ____ ABANDONMENT IN PLACE <br /> EPA SITE 1 CAC 000175933 PROJECT CONTACT 4 TELEPHONE-1 E. L. Phil lips —(209) 95 -8177 <br /> F FACILITY NAME MCI Telecommunications Corporation PHONE 1 <br /> -- — - - --LEZ— <br /> ADDRESS 28499 S. Corral Hollow Road , Tracy, CA-- --- 73 Z —Zo 7 y <br /> L CROSS STREET Linne Road <br /> I <br /> T OWNER/OPERATOR MCI Telecommunications Corporation PHONE 1 <br /> Y <br /> C CONTRACTOR NAME3im Thorpe Oil Inc. PHONE 1 (209) 462-4581 <br /> 0 <br /> N CONTRACTOR ADDRESS 351 N. Beckman Road CA LIC 1 495699 CLASS A, Haz. <br /> T <br /> R INSURER on file WORK.COMP.1 on file <br /> C FIRE DISTRICT" PERMIT 1/INSPTR + _ <br /> T _ <br /> 0 LABORATORY NAME Canov <br /> onie EnviroAmental PHONE 1 (209) 983- 1340 <br /> R _ <br /> SAMPLING FIRM# same SAMPLING METHOD Brass tube - See #5 on removal plan <br /> T TANK 10 1 TANK SIZE CHEMICALS STORED CURRENTLI CHEMICALS STORED PREVIOUSL <br /> A �_ --l�f�- p 550 Diesel <br /> N 39 double wall fiber 1 ss " — <br /> K 39 <br /> --------------------------- - <br /> 39---------------------------- — <br /> 39 <br /> --------------------------- <br /> LIST ADDITIONAL TANK INFORMATION AS NEEDED ON SEPARATE FORM <br /> P APPROVED PPROVEO WITH CONDITIONS _ DISAPPROVED <br /> L (SEE ACHMENT WITH CONDITIONS) <br /> A PLAN REVIEWERS NAME PCE DATE-----------Z <br /> ----------- - -- <br /> N ----- <br /> --------------- <br /> n -� <br /> APPLICANT MUST PERFORM ALL WORK IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, STATE LAWS, AND RULES AND REGULATIOM m 3 <br /> OF THE SAN JOAQUIN LOCAL HEALTH DISTRICT. OWNER OR LICENSED AGENT'S SIGNATURE CERTIFIES THE FOLLOWING: 'I CERTIFY TQT C to <br /> IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, I SHALL NOT EMPLOY ANY PERSON IN SUCH MANNER AS TO BES CU m Z <br /> SUBJECT TO NORKER'S COMPENSATION LAWS OF CALIFORNIA.' CONTRACTOR'S HIRING OR SUBCONTRACTING SIGNATURE CERTIFIES THE CJ <br /> FOLLOWING: 'I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, 1 SHALL EMPLOY PERSONS SUBJE <br /> TO WORKER'S COMPENSATION LAWS OF CALIFORNIA. <br /> CALL0 NSPEC S LEAST 48 HOURS IN ADVANCE <br /> 518NE0 <br /> OFFICE EON T--EI 23 046 12l88 <br /> -------- =- ------ ------ DATE 5/16/89---------------------- <br /> {{{{if{{tfftiffffffffitffffifffffflftfifffffiffiff{ffifffi fifflitffifitffifffffif{1f4itfff{i4fftffffftfifftfiftfffffffff <br /> RYEEPS I C 1 LOC CODE I DIST CODE AM0yj1T v AMOUNT�VD CKI/CASH RCVD BY DATE RCV PERMIT 1 <br /> z Yl— f: <br /> ZSR �S'{L <br />